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Value of Delayed Imaging in MDCT of the Abdomen and Pelvis

Shreyas S. Vasanawala1 and Terry Desser1

1 Both authors: Department of Radiology, Stanford University, 300 Pasteur Dr., Stanford, CA 94305-5105.


Figure 1
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  		Fig. 1A —26-year-old woman 5 days after cesarean section for breech presentation. Patient had laboratory evidence of hemolysis, elevated liver enzymes, and low platelet count (HELLP). Initial contrast-enhanced image shows uterus (arrow) with hemoperitoneum anteriorly.

 

Figure 2
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  		Fig. 1B —26-year-old woman 5 days after cesarean section for breech presentation. Patient had laboratory evidence of hemolysis, elevated liver enzymes, and low platelet count (HELLP). Image delayed by 5 minutes again shows uterus (black arrow) with anterior pooling of contrast material in a hematoma (white arrow), suggesting active extravasation. These findings were confirmed during embolization of left inferior epigastric artery later that day.

 

Figure 3
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  		Fig. 2A —18-year-old man who experienced rollover motor vehicle collision. Initial contrast-enhanced image shows splenic laceration (arrow).

 

Figure 4
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  		Fig. 2B —18-year-old man who experienced rollover motor vehicle collision. Image delayed by 7 minutes shows active extravasation as area of high attenuation lateral to spleen (white arrows). Despite active extravasation from splenic laceration (black arrow), patient required only 2 U of packed RBCs.

 

Figure 5
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  		Fig. 3A —80-year-old woman pedestrian was struck by motor vehicle and suffered multiple pelvic fractures (arrowhead, A). Initial contrast-enhanced CT scan shows evidence of active extravasation (arrow) just lateral to right pubic symphysis and hint of extravasation just posterior to left pubic body.

 

Figure 6
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  		Fig. 3B —80-year-old woman pedestrian was struck by motor vehicle and suffered multiple pelvic fractures (arrowhead, A). Image delayed by 2 minutes confirms right (black arrow) and contralateral (white arrow) extravasation. Patient required bilateral hypogastric artery embolizations.

 

Figure 7
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  		Fig. 4A —70-year-old woman after motor vehicle accident. Arterial phase image shows right clavicular fracture and adjacent high-attenuation foci (arrow).

 

Figure 8
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  		Fig. 4B —70-year-old woman after motor vehicle accident. Delayed image confirms these foci (arrow) as active hemorrhage, not bone fragments.

 

Figure 9
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  		Fig. 4C —70-year-old woman after motor vehicle accident. Arterial phase image (C) also shows retrosternal high-attenuation foci (arrow), and delayed image (D) confirms this to also be active hemorrhage (arrow).

 

Figure 10
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  		Fig. 4D —70-year-old woman after motor vehicle accident. Arterial phase image (C) also shows retrosternal high-attenuation foci (arrow), and delayed image (D) confirms this to also be active hemorrhage (arrow).

 

Figure 11
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  		Fig. 5A —58-year-old man with previous replacement of aortic valve with St. Jude Medical valve. Arterial phase image (A) shows ascending aortic aneurysm (black arrow) and adjacent bilobed collection (white arrow) in pulmonic recess. Image delayed by 5 minutes (B) shows intense enhancement of portion of collection from active extravasation, indicating a contained rupture, which was confirmed at surgery.

 

Figure 12
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  		Fig. 5B —58-year-old man with previous replacement of aortic valve with St. Jude Medical valve. Arterial phase image (A) shows ascending aortic aneurysm (black arrow) and adjacent bilobed collection (white arrow) in pulmonic recess. Image delayed by 5 minutes (B) shows intense enhancement of portion of collection from active extravasation, indicating a contained rupture, which was confirmed at surgery.

 

Figure 13
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  		Fig. 6A —84-year-old woman with aortobiliac stent-graft. Arterial phase image (A) shows stent-graft (black arrow) and aneurysm sac (white arrow), revealing interval increase in size. Delayed image (B) shows region of sac external to stent-graft with attenuation similar to that within graft (arrowhead, B) and reveals an endoleak, likely from lumbar arteries.

 

Figure 14
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  		Fig. 6B —84-year-old woman with aortobiliac stent-graft. Arterial phase image (A) shows stent-graft (black arrow) and aneurysm sac (white arrow), revealing interval increase in size. Delayed image (B) shows region of sac external to stent-graft with attenuation similar to that within graft (arrowhead, B) and reveals an endoleak, likely from lumbar arteries.

 

Figure 15
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  		Fig. 7A —30-year-old man with hepatitis B. Arterial phase image shows hepatic lesion with incomplete rim of enhancement (arrow), which is not typical of hemangiomas.

 

Figure 16
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  		Fig. 7B —30-year-old man with hepatitis B. Venous phase image at 70 sec after contrast administration shows uniform enhancement of lesion (arrow) and aorta to 160 H.

 

Figure 17
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  		Fig. 7C —30-year-old man with hepatitis B. Delayed image at 160 seconds after contrast administration again shows lesion enhancement (arrow) paralleling that of aorta at 120 H. These findings suggest lesion is a hemangioma.

 

Figure 18
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  		Fig. 8A —Adult male with abnormal liver function tests. Initial contrast-enhanced image shows region of heterogeneous enhancement (arrow) in left lobe of liver.

 

Figure 19
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  		Fig. 8B —Adult male with abnormal liver function tests. Delayed image shows increasing enhancement (arrow) of this region. Biopsy confirmed cholangiocarcinoma.

 

Figure 20
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  		Fig. 9A —52-year-old man with back pain. Contrast-enhanced image reveals left hydronephrosis (arrow) with either urine leak or perinephric stranding.

 

Figure 21
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  		Fig. 9B —52-year-old man with back pain. Image delayed by 80 minutes confirms collecting system rupture (arrow). Patient eventually underwent left nephroureterectomy, which revealed undifferentiated malignant neoplasm (sarcoma or spindle cell carcinoma).

 

Figure 22
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  		Fig. 10A —Young adult male struck by automobile while riding bicycle. Initial delayed image at 4 minutes (A) shows blood clot (black arrow) in bladder. Further delayed image at approximately 10 minutes (B) shows contrast extravasation (white arrow, B), consistent with extraperitoneal bladder rupture.

 

Figure 23
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  		Fig. 10B —Young adult male struck by automobile while riding bicycle. Initial delayed image at 4 minutes (A) shows blood clot (black arrow) in bladder. Further delayed image at approximately 10 minutes (B) shows contrast extravasation (white arrow, B), consistent with extraperitoneal bladder rupture.

 

Figure 24
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  		Fig. 11A —67-year-old man with islet cell tumor. Initial contrast-enhanced image of left kidney may reflect hydronephrosis or peripelvic cysts (arrow).

 

Figure 25
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  		Fig. 11B —67-year-old man with islet cell tumor. However, delayed image at 10 minutes shows nondilated calyces (white arrow) and renal pelvis (black arrow), thus excluding hydronephrosis.

 

Figure 26
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  		Fig. 12A —71-year-old man with hematuria. Contrast-enhanced image shows either high-attenuation or enhancing mass (arrow) in right renal pelvis. Without delayed images, this may represent hematoma or neoplasm.

 

Figure 27
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  		Fig. 12B —71-year-old man with hematuria. Washout of 20 H on 4-minute delayed image indicates neoplasm (arrow). Subsequent right nephroureterectomy revealed moderately differentiated transitional cell carcinoma.

 

Figure 28
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  		Fig. 13A —67-year-old man with incidental adrenal lesion. Unenhanced CT scan shows right adrenal nodule (arrow) with attenuation of 15 H.

 

Figure 29
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  		Fig. 13B —67-year-old man with incidental adrenal lesion. Contrast-enhanced image shows enhancement of nodule (arrow) to 80 H.

 

Figure 30
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  		Fig. 13C —67-year-old man with incidental adrenal lesion. Image obtained 15 minutes after contrast administration shows 33-H lesion (arrow), indicating greater than 40% washout. This lesion is likely an adenoma; it was stable in size for more than 1 year.

 

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